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Caring for the patient with hearing loss

Caring for the patient with hearing loss. August 7, 2009. Content of today’s program. Characteristics of the deaf and hard of hearing population Typology Signs and symptoms Emotional needs Funeral services and end of life customs Interventions Communication modifications

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Caring for the patient with hearing loss

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  1. Caring for the patient with hearing loss August 7, 2009

  2. Content of today’s program Characteristics of the deaf and hard of hearing population Typology Signs and symptoms Emotional needs Funeral services and end of life customs Interventions Communication modifications Assistive technology Interpretive services

  3. Presenters Valerie Stafford-Mallis – MBA - Training/Education Programs Coordinator – Department of Health – Florida Coordinating Council for the Deaf and Hard of Hearing Joan Haber – Certified Hearing Loss Support Specialist – Hearing Loss Association of FL – Florida Coordinating Council for the Deaf and Hard of Hearing Donna Carlton – Executive Director – Community Center for the Deaf and Hard of Hearing of Sarasota and Manatee

  4. Learning Objectives Learn to recognize the 4 types of hearing loss Learn to recognize the physical & emotional manifestations of hearing loss Learn to select appropriate communication modifications Learn to select appropriate assistive technology Learn to select appropriate assistive services Learn to utilize community resources Apply knowledge to end of life care

  5. Content (continued) Resources Questions and Answers

  6. Recognizing Hearing Loss

  7. Iatrogenic Causes of Hearing Loss Head and neck radiation Undiagnosed tumors and syphilis Ototoxic drugs Cisplatin (occurs virtually 100% of the time) Mustard, Vinblastine, Vincristine, Carboplatin, DCM Aminoglcoside antibiotics ( Gentamicin, Tobramycin, Neomycin) occurs 25% - 30% of the time NSAIDS Diuretics Quinine Derivatives

  8. Other Symptoms of Ototoxicity Tinnitus Distorted Hearing (hyperacusis) Auditory hallucinations Feelings of fullness Dizziness & vertigo Loss of balance Central auditory processing disorder Otitis media and otitis externa

  9. Physical & Emotional Considerations of Hearing loss

  10. Types of Hearing Loss Deaf Hard of Hearing Late Deafened Deaf-Blind

  11. Degrees of • Hearing Loss • Mild • Moderate • Severe • Profound

  12. The Speech Banana

  13. Deaf Sense of hearing is non-functional without the use of technological assists May be congenital or acquired deaf vs. Deaf

  14. Hard of Hearing Can range from mild – moderate – severe – profound Can affect one or both ears Onset is usually gradual but can be rapid

  15. Late deafened Usually severe to profound Occurs after speech and language are fully formed

  16. Deaf-blind Substantial loss of hearing and vision May necessitate an SSP – Support Services Provider Does not have to mean total loss of hearing and vision It’s important to know the degree of residual vision and hearing to determine the appropriate type of visual, auditory, or tactile communications methods

  17. Emotions Common to Loss of Hearing Grief Shock and Denial Anger Bargaining Depression Acceptance

  18. Hearing loss is linked to: • irritability, negativism and anger • fatigue, tension, stress and depression • withdrawal from family and social situations • social rejection and loneliness • reduced alertness and increased risk to personal safety • impaired memory and the ability to learn new tasks • reduced task performance & independence • diminished psychological and overall health

  19. Effective communication with the deaf and hard of hearing patient Sensitivity Courtesy Common sense Shared responsibility between speaker & listener Don’t be afraid to ask Whatever works!

  20. Effective communication with the deaf and hard of hearing patient Attention Noisy background Light Be seen Obstacles Foreign objects Diction and speech Pace Volume

  21. Effective communication with the deaf and hard of hearing patient Facial expressions and gestures Conversational transition cues Rephrase instead of repeating Talk TO a hard of hearing person, not ABOUT him or her. When in doubt, ASK Be patient, positive, and relaxed.

  22. Guidelines for Communicating with a Person Who Uses Sign Language Get their attention first gentle tap on the shoulder, wave, flash lights, stomp on the floor hand slap a table. Use paper and pen while waiting for the Interpreter to show up Use open-ended questions to probe for understanding.

  23. Guidelines for Communicating with a Person Who Uses Sign Language Always use interpreter for informed consent When the interpreter is present, talk directly to the person who is deaf, not the interpreter. Don’t talk about the person in their presence Don’t say “Ask him/her” or “Tell him/her” Maintain eye contact. It is considered rude to carry on a conversation without maintaining eye contact.

  24. Guidelines for Communicating with a Person Who is Deaf-Blind Notify the agency/interpreter that the person is deaf-blind Advise agency which mode of communication is needed (visual sign language or tactile sign language). To walk with a deaf-blind person offer an elbow and your forearm. Guide - Never push or pull them along. Do not leave deaf-blind persons alone in an open space. Escort them to a safe place and let them know why you are doing this.

  25. Types of Interpreters Sign language Interpreter Oral interpreter Multi-lingual interpreter Deaf-blind interpreter Video relay services Video remote interpreting CART _ Communication Access Real-time Translation

  26. Finding Medical Interpreters Bradenton Office 5107 14th Street West (U.S. 41/Tamiami Trail)Bradenton, FL 34207941.758.2539 V/TTY941.758.2541 VP941.758.3564 Fax Venice Office 628 Cypress AvenueVenice, FL 34285941.921.5447 V/TTY

  27. Finding Medical Interpreters Call CCDHH to help you find www.ccdhh.org Registry of Interpreters for the Deaf website www.RID.org lists RID-certified interpreters by state along with their certifications See RID Standard Practice Paper – Interpreting in Healthcare Settings Florida Registry of Interpreters for the Deaf (FRID) www.fridcentral.com

  28. Qualified vs. Certified Interpreters ADA mandates qualified interpreters Qualified interpreters Sign to the deaf individual(s) what is being said Voice to the hearing individual (s) what is being signed Accurately convey at least 95% what is being communicated Must be impartial Must maintain patient confidentiality Must facilitate effective communication

  29. Family members are the worst interpreters They may be emotionally distraught They are seldom objective They may be unable to deliver difficult news Confidentiality is an issue Their use is not legally defensible in a court of law for all but the most extreme emergencies and even then, only until a qualified interpreter can be sought.

  30. Telecommunications Devices And Services

  31. Who Is FTRI?Florida Telecommunications Relay, Inc. Administrator of TASA Law (F.S. 427) A private not-for-profit organization NOT a state agency Governed by Board of Directors. Located in Tallahassee. Create awareness, educate public and promote the Florida Relay Service. Distribute specialized telephones to Florida residents.

  32. Authorized FTRI Distribution Center Bradenton Office 5107 14th Street West (U.S. 41/Tamiami Trail)Bradenton, FL 34207941.758.2539 V/TTY941.758.2541 VP941.758.3564 Fax Venice Office 628 Cypress AvenueVenice, FL 34285941.921.5447 V/TTY

  33. Florida RelayTypes of Customers • TTY/TDD • Is for individuals who are Deaf, Hard of Hearing, Deaf/Blind, or Speech Disabled. • Allows a person to type his or her own conversation through the relay OPR who then voices aloud the typed conversation to a hearing person.

  34. Florida RelayTypes of Customers • Voice Carry-Over (VCO) • VCO allows deaf or hard-of-hearing individuals who prefer to use their own voice to speak directly to the party they are calling. • The operator will type the voice responses back to the VCO user who reads the typed message across the text screen

  35. Florida RelayTypes of Customers CapTel (enhanced VCO)

  36. Florida RelayTypes of Customers • Hearing Carry-Over (HCO) • HCO allows people who are speech disabled to use their hearing abilities to listen directly to the other party • The operator then voices the typed responses from the HCO user to the hearing person, who then speaks directly to the HCO user

  37. Florida RelayTypes of Customers • Speech-to-Speech (STS) • Speech to Speech allows individuals with speech disabilities to use their own voice, while utilizing the assistance of specially trained operators to make their calls. • When spoken words become difficult to understand, the operator assists verbally, making communication between both parties as clear and personal as possible

  38. VCPH… Volume Control Phone for the Hard of Hearing Makes incoming speech clearer. Includes a volume control adjustment. FTRI EDPAmplified Telephones Clarity’s XL-40 (40 dB) ClearSounds’ CSC-40 (40 dB) Krown’s Starplus (53 dB) Clarity’s W425 (30 dB)

  39. ILA … In-Line Amplifier (40 dB) Connects to a standard telephone. Increases the volume and makes incoming speech clearer. Provides more amplification. FTRI EDPSpecialized Equipment ClearSounds’ CS-IL40 Clarity’s HA-40

  40. VCO… Voice Carry-Over Telephone Allows a person to receive a text message through a relay service and verbally reply to the caller with his or her own voice. “read and talk phone” FTRI EDPSpecialized Equipment

  41. CAP TEL CapTel User Other Party 1. You talk to the other party… 2. …who talks back to you to hear. 5. …for you to read on the CapTel display. Captioning Service 3. Everything they say also goes through a Captioning Service… 4. …who re-voices what is said to a powerful voice recognition system which transcribes the words into captions…

  42. TTY… Text Telephone Used to type a message to another TTY user or a person using a standard telephone through the Relay service. Built-in flasher that lights up when the phone rings. FTRI EDPSpecialized Equipment Ultratec’s 4400 Krown’s MP2000D Krown’s PP2000D

  43. VCPS… Volume Control Phone for the Speech Impaired (26 dB) Provides more volume for outgoing speech. Rings at 95 dB and amplifies incoming sound to 40dB. FTRI EDPSpecialized Equipment

  44. ARS… Audible Ring Signaler (95 dB) Plugs into a jack away from the telephone. Or connects directly to the telephone. Rings when the telephone rings and allows you to adjust tone and volume. FTRI EDPSpecialized Equipment Ultratec’s CrystalTone Clarity’s SR-200

  45. www.ftri.org One destination for all information regarding the program User friendly and accessible to everyone FTRI Website

  46. Assistive Listening Devices Pocket sized personal amplifiers TV Listening systems FM Systems Stethoscopes Loop Systems Various Accessories

  47. Assistive Devices & Services Alarm clocks Timers and watches Door signalers Phone/strobe signalers Paging systems Weather Alert systems Visual/auditory/tactile alerters

  48. ADVOCATES FOR BETTER HEARING A Local Sarasota 501 c 3 Flo Innes, Founder and President Call(941) 373-0084 Open Monday - Thursday 10 am to 4 pmOr by appointment.2075 Main Street, Sarasota FL 34237, Suite 5    (Located 2 blocks east of 301 on the corner of East Ave and Main Street).  Parking lot and showroom entrance in rear of building.Visit the showroom to see and test the many assistive devices.  Email: info@advocatesforbetterhearing.com

  49. End of Life Services & Customs The Deaf community is a close knit community Legacy.com - They rely on email and texting Accessible memorial and funeral services ASL CART Voice interpreters Written personal life history of the deceased

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